外科的臨床推理教學

Teaching of Clinical Reasoning in Surgery

臨床推理能力是所有臨床科醫師都需具備的基本技能，發展有效的臨床推理知能是外科醫師訓練主要的核心目標之一，特別是在手術房中，它攸關開刀當下的決策。對醫學生而言，本文強調術中以解剖學為基礎的過程推理教育，整合課堂上分析性的演繹推理（deduction）與臨床上綜合性的歸納推理（induction），在實境中學習成長。在醫學教育中，不同的學習階段，需要因材施教，給予不同的學習內容，以達到學習者最大的教育成效。這當中，臨床的教學施以立即評量與回饋可提供受訓者最有效的思路架構訓練與知能獲取。然而外科醫師在手術中要面對許多不確定性與困境，惟有透過不斷的臨床推理訓練，並能自我導向終身學習，才能豐富大腦的工作記憶庫，精進術中的決策推理能力。

Clinical reasoning is an essential skill for all physicians regardless of their professional fields. The development of effective clinical reasoning, especially the decision making skills in operation rooms, is a core aim of surgical training. This article emphasizes the anatomy-based education on teaching intraoperative reasoning process by integrating the deductive model in the classroom and the inductive model in clinical settings through participating in patient care activities. In order to maximize the educational effectiveness, multiple teaching strategies are selected in parallel with the various expertise levels of competence on clinical reasoning. Assessment followed by timely feedback is considered effective in establishing learners’ knowledge structure and the abilities of retrievals. To successfully handle many uncertainties and difficulties during operations, self-directed learning along with practices on clinical reasoning is crucial.